1. Colin McInnes Simon Rushton Owain Williams

4. From NHS to ‘Global Health’

5. Competing interests: national vs global

6. Competing interests: economics vs rights

7. Too many actors?

8. Competing visions? Economics Development RightsSecurity Biomedicine

10. THE ACCESS ISSUE

11. THE BOTTOM LINE

13. Some pharmaceutical data Global pharmaceutical market estimated around US$ 663 billion in 2007 80% of global pharmaceutical sales in the US, Canada and EU in 2007 According to industry, a new medicines costs around US$ 1 billion and takes around 12 years Less innovative: number of NEW DRUGS per year has fallen from around 93 in 1960s, to 48 in the 1980s and 27 in 2000s Only around 5% of pharmaceutical R&D goes towards cures for diseases such as malaria, TB and others confined to patients with no purchasing power Cost of medicine around 17% of health care budget in most developed countries but up to 60% in the rest of the world

14. TRIPs and access to medicines TRIPs brought a sea change in IPRs for pharmaceuticals with important implications for access to medicines Pharmaceutical patents (Length /Type) Pharmaceutical data protection Compulsory licensing TRIPs not concerned with public health per se; recognised in principle (Art 8), but measures cannot be inconsistent with TRIPs provisions From 1995 onwards, there have been continuous efforts to narrow down TRIPs flexibilities through: Unilateral pressure Legal interpretation of TRIPs provisions at the multilateral level Technical assistance and design of IP laws at the domestic level 2001 Doha Declaration reaffirmed TRIPs flexibilities but the battle continues

15. The battle continues Continuous pressure when flexibilities are used Compulsory licenses in Thailand and Brazil (2006, 2007) Patentability criteria in India; Novartis and Bayer court cases US Special 301 list (from 2000 onwards, half of countries listed due to ‘inadequate’ IP protection for pharmaceuticals) EU introduced its ‘watch list’ version in 2006 The new IPR enforcement Agenda Generics and counterfeits: seizure of drugs in transit in Europe (20 cases during 2008) Anti-Counterfeiting Agreement (ACTA) negotiations

16. EU-India negotiations (2007-) India seen as the ‘pharmacy of the world’; reportedly, around 90% of generic AIDS drugs used in developing countries come from India India amended its patent law in 2005 to comply with TRIPs Balanced provisions with safeguards against unnecessary patents; patient groups can challenge patents Key issues: Patent extension, 5 years (draft Art.9.3) Data protection, EU model 11 years, not accepted by India (draft Art.10) IPRs enforcement provisions (draft Art12-28) beyond TRIPs, applicable to imports, exports and goods in transit IN THE MEANTIME BIG PHARMA BUYS INDIAN FIRMS...

17. Rock & Roll: Global Health and Celebrity Diplomacy

18. Bono The Quintessential Outsider-Insider

19. George W. Bush on Bono Bono bounded into the Oval Office with his high-voltage personality and signature shades. He quickly dispelled the notion that he was a self-promoter. He knew our budgets, understood the facts, and had well-informed views about the challenges in Africa. He brought me a thoughtful gift, an old Irish Bible.... I listened carefully as he urged me to do more on HIV/AIDS. “With a few pills you can save millions of lives. It would be the best possible advertisement for the United States. You ought to paint the things red, white and blue.” After our meeting Bono joined me... at a speech at the Inter- American Development Bank. Bono participated in the event and praised our policy. George W. Bush, Decision Points (Random House, 2010), pp.348-9.

20. Gates: Mega-philanthropy and political influence

22. Global health heroes?

23. When PEPFAR got off to a slow start, he [Bono] came to see me in the Oval Office. “You’re the measurable results guy,” he said, “so where are the results?” I would have told him, but he wouldn’t let me get a word in edgewise. Once the program was up and running, he came back. “I’m sorry I doubted you,” he said. “By the way, do you know that the U.S. government is now the world’s largest purchaser of condoms?” George W. Bush, Decision Points (Random House, 2010), pp.349.

24. Global health heroes?